Postoperative Hypoxemia in Orthopedic Patients with Obstructive Sleep Apnea


Mary F. Chisholm, MD

Assistant Attending Anesthesiologist, Hospital for Special Surgery
Assistant Clinical Professor in Anesthesiology, Weill Cornell Medical College

Justin Ngeow, BA
Department of Anesthesiology, Hospital for Special Surgery


Raymond S. John, BA
Department of Anesthesiology, Hospital for Special Surgery


Pamela Shaw, BS
Department of Anesthesiology, Hospital for Special Surgery


Yan Ma, PhD
Department of Public Health, Weill Cornell Medical College
Department of Epidemiology and Biostatistics, Hospital for Special Surgery


Stavros G. Memtsoudis, MD, PhD
Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College

Abstract 

Criteria to determine which patients with obstructive sleep apnea (OSA) require intensive postoperative monitoring are lacking. Our postoperative OSA patients are all intensively monitored in the PACU and can provide such data. Thus, we reviewed patient records to determine incidence and risk factors for postoperative hypoxemia in OSA patients and subsequent association with postoperative complications. Five hundred twenty-seven charts of patients with OSA based on preoperative ICD-9 codes were reviewed for outcomes including episodes of hypoxemia and hypercarbia. Univariate analysis, logistic regression, and propensity analysis were performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Thirty-three and 11 percent of these patients developed hypoxemia or hypercarbia. Risk factors for hypoxemia were hypercarbia, home bronchodilator use, BMI =35, and estimated blood loss =250 ml. Patients with hypoxemia had significantly more respiratory interventions and increased intensity of care. Patients with hypoxemia had significantly increased length of stay and risk of wound infections. Severe hypoxemia was associated with significantly more interventions than mild hypoxemia. Propensity analysis confirmed significant association of hypoxemia with adverse outcomes after adjustment for pre-existing risk factors. We conclude that postoperative hypoxemia in OSA patients is associated with adverse outcomes. Risk factors for hypoxemia were identified to guide allocation of monitoring resources to high-risk patients.

This article appears in HSS Journal: Volume 7, Number 1.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


^ Back to Top
Request an Appointment